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Note: Carefully read and follow the directions to complete the form and generate a PDF version that can be attached to the final application. All narrative responses and PDF appendices must be submitted as one application.

The applicant LEA assures the Commission that if awarded grant funding:
  1. All residents will work at least one-half time alongside a school counselor of record, who is designated as the experienced mentor school counselor, for at least one full school year while engaging in initial preparation coursework. (Appendix A (b)(2))
  2. The Commission-approved pupil personnel services preparation program specializing in school counseling offered at the regionally accredited IHE will enroll candidates in the program and recommend them for the clear pupil personnel services credential once all requirements have been met
  3. Grantee LEAs will prepare residents to become school counselors and eventually be hired in a school within the jurisdiction of the grant recipient.
  4. All residents agree in writing to serve in a school within the jurisdiction of the grant recipient that sponsored the candidate, or another public school in California, for a period of at least four academic years. The service commitment will begin with the school year immediately following the candidate’s successful completion of the preparation program and upon earning a pupil personnel services credential. (Appendix A (k))
  5. The LEA will participate in SRTAC programming and events.
  6. The LEA and IHE will participate in regularly occurring shared governance meetings.
  7. The LEA and IHE will cooperatively collect, analyze, use, and report data annually. The partnership will comply with the Commission’s mandated reporting requirements, submitted by stated due dates, including but not limited to:
    1. School Counselor Residency Implementation Grant Program Annual Report. The report template is available upon request. This report is updated by the grantee every year in the grant reporting cycle.
    2. Results from candidate and program graduate surveys of the quality of preparation they received.
    3. Best practices found to be effective in implementing the program.
    4. Factors promoting or hindering residency program implementation.
    5. Lessons learned to inform future investments in school counselor residency programs.
Administrative approval from the Superintendent of the applicant local education agency (LEA)
*It is expected that if the application represents a consortium, ALL LEA partners will each sign an agreement, including partner LEAs within a county office of education.
By signing below, I affirm that:
  1. I have thoroughly read and agree to all portions of this application including the assurance statements included on this form.
  2. All statements and data contained in this application are accurate.
  3. If awarded a School Counselor Residency Implementation Grant, the LEA agrees to participation in the activities described as well as the timelines and budgets included in the responses to criterion 1-9 in Section II of this application.



Approval from the Human Resources representative from the applicant local education agency (LEA):
*It is expected that if the application represents a consortium, an HR representative from each LEA partner will sign an agreement, including partner LEAs within a county office of education.
By signing below, I affirm that I have thoroughly read and confirm that the data and narrative included in the response to RFA Question #2 (Local Need) is accurate.




Administrative approval from an authorized administrator of the applicant’s IHE partner(s)
*It is expected that EACH IHE partner will sign an agreement.
By signing below, I affirm that:
  1. I have thoroughly read and agree to all portions of this application including the assurance statements included on this form.
  2. All statements and data contained in this application are accurate.
  3. If awarded a School Counselor Residency Implementation Grant, the IHE agrees to participation in the activities described as well as the timelines and budgets included in the responses to criterion 1-10 in Section II of this application.




Reset Appendix D Appendix G